With the exception of stiff proximal interphalangeal joints, most secondary deformities in burned hands are amendable to well-established technics of restorative hand surgery. The purpose of this paper has been to emphasize the devastating effect of proximal interphalangeal joint stiffness, and to strongly recommend that burns of the hand and wrist be excised and resurfaced as soon as possible so that motion in the interphalangeal joints can be started in at least 7-10 days after injury. The danger of excising a deep second degree burn which might have healed without grafting should not be a deterrent to early excision and grafting as skin which is this badly damaged usually does not heal without severe scarring which will ultimately require replacement for satisfactory function. Moreover, the danger of making an inaccurate assessment of the depth of the burn or of having a secondary infection produce a 3rd degree defect, which will necessitate placing a graft on granulation tissue after a period of several weeks'' immobilization, is so serious that we are of the opinion that early excision and grafting should be done whenever there is doubt as to the depth of the burned area.